Transcript Folie 1

Semantic Interoperability
Deployment & Research Roadmap
Veli Stroetmann, empirica
with
Alan Rector, UNIMAN
Dipak Kalra, UCL
Bedirhan Ustun, Pierre Lewalle, WHO
Karl Stroetmann, Benjamin Jung, empirica
Pieter Zanstra
Jean Marie Rodrigues, UJM
Martti Virtanen, UU
Gyorgy Surjan, ESKI
i2010 Subgroup on eHealth meeting
21 February 2008, Brussels
What are we talking about?
Defining IOp:
Health system interoperability is the ability,
facilitated by ICT applications and systems,
– to exchange, understand and act on citizens/patient
and other health-related data, information and
knowledge
– among linguistically and culturally disparate
clinicians, patients and other actors
– within and across health system jurisdictions in a
collaborative manner
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Why do we need Semantic IOp?
Health system priorities and goals
To support the goals of greater patient safety, better quality of care, chronic
disease management, extended homecare or patient empowerment,
clinical meaning (data, information, knowledge)
must be expressed consistently
– to enable the safe, meaningful sharing and combining of health record
data between heterogeneous systems and actors / care providers;
– to enable the integration and safe use of computerised protocols,
alerts and care pathways by EHR systems;
– to link EHR data to explanatory and educational materials to support
patient and family engagement and professional development;
– to ensure the necessary data quality and consistency to enable
rigorous secondary uses of longitudinal and heterogeneous data for
public health, research, health service management.
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Roadmap: Recommendations - General Principles
• Focus on concrete, immediate needs and real use cases with
expected high benefits & lower costs
• Terminologies should have a well defined scope and purpose
– be delivered against well defined, realistic time scales
• Separate:
– Ontology - what you mean
– Language - how you say it
– Interface - how you find it
• Involve vendors/industry and human end users - clinicians, citizens
– Be responsive
– Be open, collaborative and participative
• Make it multilingual and multicultural
• Focus on Quality Assurance and Reproducibility
• Use today’s technology
– modern ontology languages, Web 2.0, “Just in time”
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Some Recommendations on Structures and Process
• Governments to develop, implement and sustain longer-term
visions, objectives and measures
• Establish national centres for multilingual, multicultural
adaptation of international classifications including SNOMED
• Link them in a well-managed European network of
Competence Centres
• Establish a European Network of Terminology Servers
• Assure sustainability and scalability
– It must be maintained to be useful
– Beware of silver bullets
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Socio-economic Assessment: Optimising Semantic IOp
Benefit
Cost
high
Benefit
Δmax
medium
Cost
Degree of
Interoperability
low
0
Degrees D
Dx
D100
optimal: Dopt
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Terminologies: SNOMED-CT - Current Assessment
• Controlled vocabulary and identifiers
– Well managed but slow response time
• Hierarchies and relations
– Unusable
•
•
•
•
Too unreliable to depend on to behave as documented
Systematically flawed in principle
Limited by software and logic limitations from early 1990s
Cost of repair probably exceeds cost of rebuilding - but still modest
• Multilingual / Multicultural support
– Minimal
• Neither understood nor a priority for the IHTSDO
– Spanish and Canadian-French versions might appear
• Openness and accessibility to Social Computing
– Unusable - remains effectively closed
• Not generally available on the Web
• Opportunity cost of participation prohibitive
• Influencing policy difficult
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Terminologies: Selected Recommendations
• Support for specific initiatives between ICD/WHO ISO and SNOMED to
develop ICD-11 along with mappings to/from SN
• Support feasibility study (select subset of ca. 25,000 terms / use case) of
reformulation of SNOMED to
–
–
–
–
build reliable hierarchies & relations
develop multilingual support
introduce social computing tools
empirically assess individual, organisational and societal benefits & costs
• Support open tools for terminologies that link up to SNOMED
• Support social computing efforts (Web 2.0) on ICD-11
• Develop language technologies
– Text extraction to build new terms and encode natural language
– Text generation to present and for QA
• User involvement & ownership, a series of centres & initiatives
• Support training at all levels
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Roadmap for SIOp Deployment & Research - Ontologies
2021
Policy with
2016 MS on future
2014
2012
2011
use of
hierarchies
& relations
Statistical
extension of
QA
Formal QA
of subset
Central
Reference Sustainable
Services Centres for
Selected
Ontologies
Toolkit
for HL7
messages & Large Scale
archetypes Environment
binding
Local
mappings
to UMLS
Multilingual
-cultural
adaptation
Intern.
Biobanking
collaboration
Actions
Collaboration
Social
arising from
Research on with EBI and
Computing
Multilingual
consultations
NBCO
consequences
based
-cultural
of different
Terminology
2009
subsets
commitments
Service
European
Feasibility Study
Ongoing
Centres of
Tools for
&
reformulation
consultations
Excellence
2008
Toolset for
Terminfo
of subset
Feasibility Study
test
2010
SNOMED
LOINC,
DICOM
Sustainable
framework
with EU
Industry for
effective
standards
development
TerminoloOntologies
Genomics
Socio-Econ.
gies & EHRs9
Transl. Medicine
Issues
Roadmap: Ontologies Action Plan
Content
Process
Tools
Open ICD 11 with SNOMED
Mappings
 Establish Open collaborative
framework for ICD11
 Open tools for ontology
development
Reformulation of SNOMED
 Begin to establish mechanisms
for industrial involvement
 Open Web 2.0 tools to
support ICD 11
 Quality assurance metrics for
SNOMED Fragment
 Extend industrial involvement
 Develop tools for linking
and binding terminologies
and archetypes
Year
2008
2009
 First translations of SNOMED
Fragment
2010
 Continue
2011
 Reassess and create long
term plan for selected
terminologies including limits
on scope
20122013
 Establish formal collaboration
with European BioBanking and
EBI
 Establish mechanisms for
reformulation of SNOMED
Fragment
 Establish open social site
for clinical terminology
 Extend and test open tools
for terminology and
Archetypes, possibly with
inclusion of HL7
Establish European Network
of Terminology Servers
 Review and reassess
interoperability
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Roadmap EHR: Basic elements and short term actions
• Effective, functional EHR systems need:
1. Generic reference models for representing clinical (EHR) data
e.g. EN 13606, HL7 CDA, openEHR Reference Model
2. Agreed clinical data structure definitions
e.g. openEHR archetypes, HL7 templates, generic
templates and data sets
3. Clinical terminology systems
e.g. LOINC, SNOMED-CT
• Areas needing adoption (short term):
– Agree on a generic model for EHR communications: consider EN13606
– Adopt a standardised approach for representing and sharing of clinical data
structure specifications: agree to use archetypes / templates
– Collaborate on key use cases for shared care & patient safety, and on defining &
tidying up the corresponding terminology/SNOMED-CT sub-sets
– Seed clinical fora to develop care pathways and archetypes to meet the needs
of safe and evidence based care in different medical domains and disciplines
– Strengthen clinical user training in the use of EHRs, terminology and structured
records
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Roadmap EHR: Medium term actions
• Areas needing wide-scale evaluations:
– Develop best practice in archetype design
– Establish useful exemplars of SNOMED-CT sub-sets being adopted within
EHR systems and delivered in meaningful ways to clinical users
– Develop the business rules and validation processes
– Identify and evaluate the benefits for various stakeholders & health
systems
• Areas needing investments:
• Industry sponsored or nationally supported open source approaches for:
– Archetype & template authoring and validation tools
– Terminology servers, term browsers for SNOMED CT, support for term
coordination
– Global multi-cultural dimension - not just term translation but
internationalisation across health care paradigms and cultural differences
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Roadmap for SIOp Deployment & Research - EHR
2021
2016
2014
2012
2011
2010
Term
Binding
Repositories
QA &
Certification
Best Practice
A. Design
Authoring/
Validation
Tools
Care Pathways
2009
2008
Generic Model
for EHR
Communication
Reference
Model
Standardised
Represention
Clinical Data
Structures
Archetypes
Global
Experience
Test
Consistency
Test HL7
Terminfo
Terminology
Servers
Term Browsers
Adaptable
Clinical
Applications
Acceptance
Evaluation
EHR
Visualisation
Applications
Business Rules
for TC
Link EHR to
Educational
Material
Agree on SIOP
Goals for PHR
SNOMED-CT
Subsets
Improve Internationalisation
Policies on SN
Term Coordination
(TC)
EHR/Terminology
User Training
Key Use Cases
Terminology
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SNOMED-CT
Applications
Socio-economic
Issues
Roadmap Public Health: Long term goals
•
•
•
Consistent use of EHRs as person-based health records in clinical settings
Interconnecting health service providers so health information can be exchanged
through interoperable digital means in a standard fashion
Research to prove the comparability of digital information with analog traditional
measures used for monitoring and evaluation in various health inf. systems
Interoperability
Levels
FULL Semantic
Interoperability
Some Semantic
Interoperability
Technical
Interoperability
NO
Interoperability
EHR
Common
Standards
Exchange
Content
Data, Norms,
Standards
Services
Environment
Metadata
3 years
Knowledge
Organization
5 years
7 years
10 years
Multilevel Ontologies
Linguistic
Representations
Legal
Requirements
Population
EHR
Common
Standards
Multiple Languages
Liability
Security
Privacy
Ownership
Intellectual
Property
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Mandate
Organization
Time
Roadmap Public Health: Actions
Requirements for SIOp:
•
•
•
•
•
Interconnection tools
Identification management
Common web services
Security technologies
Mechanisms for ensuring the sustainable operation of these components
on a widespread and publicly available basis
Action points:
• Enable common standards to allow data exchange on predefined key
variables & compilation of content
• Compile data across populations and across health care providers
• Link data across multiple care settings
• Compare data across regions, time or populations
• Set up organizational and legal regulations in a sustainable fashion
• Develop global registries of standardized information models and related
metadata
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Roadmap for SIOp Deployment & Research – Public Health
2021
2016
2014
2012
Bio
Banking
Case-Mix
Grouping
Online
Epidemiology
on selected
conditions
2011
Patient Flow/
Statistics
2010
International
Health
Regulations
2009
2008
Electronic
Death
Certifiation
Classifications
Metadata for
populations,
settings and
GIS
Linkage to
Population
Registries
Demography
Predefined
Reportable
Diseases
Biosurveillance
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Mandate the
organisation
of PH
information
gathering
Common
Standards
for Content
Common
Standards
for
Exchange
Public Health
Infrastructure
IPR,
Ownership
Legal
Requirements:
Liability,
Security,
Privacy
Socio-economic
Issues
Final Report: Roadmap Matrices & Action Plans
Roadmap Matrix on Ontologies (excerpt)
Time
Content
Tools
Processes
Sh
ort
Ter
m
ToDo
Feasibility study and semantically sound
reformulation hierarchies and relations for a of
subset of SOMED
x
C1
C2
Multilingual multicultural versions of
semantically sound subset
x
C3
Content
SNOMED
C4
X
Statistical extension of QA to all of SNOMED
x
Policy in conjunction with member states on
future of use of SNOMED hierarchies and
relations
C6
Consultation on issues related to LOINC &
DICOM
x
Consultation on issues related to Adverse
reaction reporting and Drug Reporting
x
C8
Content
Other
Actions arising from consultations
[1] Incl. Pharma
He
alth
pro
fes
sio
nal
s
Re
sea
rch
ers
SD
Os
Ind
ust
ry
x
x
x
x
X
x
x
X
X
x
x
X
x
X
x
X
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Lo
ng
ter
m
Pol
icy
Ma
ker
s
x
Formal QA of Subset of SNOMED
C5
C7
Me
diu
m
Ter
m
Actors
X
x
x
X
X
x
x
X[1
]
X
X
Prereqs
T1
Final Report: Roadmap Matrices & Action Plans
Roadmap for Semantic Interoperability Deployment and Research
Tools-ContentsProcesses
Reference
Model
EHR
Archetypes
Terminology
Systems
2008
2009
2010
2011
2012
Ontologies
SNOMED
Care Pathways and
Archetypes
Standardised Represention/
Sharing of clinical data structures
Key Use
Cases
Policies on SNOMED-CT
Term coordination
Archetype/Template
Authoring/Validation Tools
SNOMED-CT
subsets
Best Practise
Archetype Design
Business Rules to
support term coordination
Terminology Server/Term
Browser for SNOMED-CT
Biosurveillance
Public Health
Infrastructure
Socio Economic
Issues
Toolset for
Feasibility Study
FORMAL QA of
SNOMED subset
Multilingual/ -cultural
SNOMED subset
Feasibility Study and reformulation of SNOMED subset
Tools/methods for Terminfo
guidelines test implementation
Demography
2021
Term Binding
to Archetypes
Consistency Test HL7
SNOMED-CT global
Terminfo Trial Standard Experience Test
Agree on Semantic Interoperability Goals for PHR
Improve Internationalisation across
HC paradigm and cultural differences
Terminologies
and EHRs
Classifications
Public Health
EHR/Terminology
User Training
Consultations on issues
related to LOINC & DICOM
Genomics/
Translational
Medicine
Socio Economic
Issues
Archetype
Repositories
Quality Assurance
and Certification
EHR Visualisation
Applications
LOINC, DICOM
Ontologies
2016
Generic Model for EHR
Communication
Technology/
Visualisation
Socio Economic
Issues
2014
Statistical extension of
QA to all SNOMED
Adaptable Clinical
Applications
Link EHR data to
educational material
Acceptance
Evaluation
Policy in conjunction with MS on future use
of SNOMED hierarchies and relations
Actions arising from
consultations
Social Computing based
Terminology Service
Research: Consequences of different
ontological patterns and commitments
Establish local European
CoE on NCI technologies
Generic Toolkit for HL7 messages and
Archetypes binding to Terminologies
Policy: Local terminologies
map to UMLS CUI & LUI
Ontology Mapping
Research
Establish collaboration with
EBI and US NBCO
Multilingual/-cultural
classification adaptation
Central Reference
Terminology Services
Large Scale Collaborative
Ontology Environment
Sustainable Centres for
Selected Ontologies
Establish international Biobanking
collaboration on terminologies
Establish sustainable framework with European Industry for
effective standards and terminology/ontology development
Electronic Death
Certifiation
Patient Flow/
Statistics
Case-Mix
Grouping
Linkage to
Population Registries
Predefined Reportable
Diseases
International Health
Regulations
Common Standards
for Exchange
Online Epidemiology
on selected conditions
Bio
Banking
Common Standards
for Content
Legal Requirements on Intellectual
Property, Ownership
Legal Requirements on
Liability, Security, Privacy
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Metadata for populations,
settings and GIS
Mandate the organisation of
PH information gathering
Proposal: Building a European Semantic IOp
Knowledge Base
SemanticHEALTH Wiki
• Semantically linked set
of documents
• Collaborative
environment (discussion
page open for everybody)
• Extensibility
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Acknowledgements
Specific Support Action co-funded by the European
Commission SIXTH FRAMEWORK PROGRAMME
Communication &
Technology Research
University College London
Centre for Health Informatics, UK
Germany
World Health Organisation
University of Manchester
Dept. Measurements & Health
Information Systems, Switzerland
Health and Bioinformatics Group, UK
National Institute for
Strategic Health Research
Uppsala University
Nordic Centre for Classifications
in Health Care, Sweden
Hungary
Radboud University Nijmegen
Medical Center
University of St. Etienne
Department of Public Health &
Medical Informatics, France
The Netherlands
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Thank you for your attention!
Further information:
www.SemanticHEALTH.org
[email protected]
Veli Stroetmann
for the SemanticHEALTH consortium
Communications & Technology Research
Bonn, Germany
[email protected]
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